Epstein Insurance Services
Business and Personal Insurance for California residents.
P.O. Box 7851, Riverside, CA 92513


Office: 951-687-1012
Fax: 951-688-6530
E-mail: Quote@urs2.net

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Worker's Compensation Insurance Quote

To find out how we can improve your insurance programs, please give us the following information. Be sure to answer the questions as thoroughly and accurately as you can. Please know that 3 years of Current Loss Runs will be required.

Please note: Your privacy is in our respectful care. We will share only the information needed with our preferred insurance carriers for quote processing only on a confidential, one-on-one basis

Please fill out the following information so we may provide you with a free consultation.

First Name
Last Name
Title
Company
Address
City
State
Zip
Telephone
Fax
E-Mail
Please Confirm E-Mail:
Web Page
Federal ID Number
Current Workers Comp Carrier
Number of Employees
Experience Mod. YES?   % 
Please list the annual payroll for each employee workers comp class code.
Claim History (Last 4 years)

We will search the current marketplace for available rating programs, as well as proven WC carriers to bring you the most up-to-date, cost effective program for your particular business.

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